High Prevalence of Musculoskeletal Pain Among Esports Athletes
Yona T1, Lindberg L2, Østergaard LD3, Lyng KD4, Rathleff MS3,4,5, Straszek CL2,3,4.
1 The Israeli Physiotherapy Society, Tel-Aviv, Israel
2 Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg, Denmark.
3 Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
4 Center for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University
5 Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital
Esports- rapidly evolving and highly demanding
Esports is a new and rapidly evolving sports discipline with a growing number of athletes engaged in structured practice and competitive tournaments with extensive money prizes. Esports has many similarities with traditional sports, like football, handball, or athletics . It includes interaction with other members or competitors, centered around competition, and requires high concentration and a specific skillset. Notably, the lack of physical activity is what makes esports stand out compared to more traditional sports. Nonetheless, many esports athletes experience musculoskeletal pain.
Becoming a skilled esports athlete requires extensive practice, and several studies suggest that professional esports athletes, on average, practice between 3.4-5.2 hours/day, corresponding to 25-35 hours/ week [2,3]. This number may increase with up to 10 hours/day before a competition, with some tournaments consisting of up to three hours non-stop, intensive gaming . Such high workloads are likely to have an impact on adolescents engaged in esports.
Musculoskeletal pain in esports
Research regarding esports is rapidly evolving – In the most extensive cross-sectional study to date, Lindberg et al. (2020) surveyed 188 Danish esports athletes, aged 15 to 35, and participating in structured esports, and found that 42% of esports athletes suffer from musculoskeletal pain . Previous smaller reports support this surprisingly high prevalence by showing approximately 2 out of 5 (40%) esports athletes suffer from either back or neck pain. Not surprisingly, upper limb pain is also common, with approximately 30-36% reporting shoulder or wrist pain [3,4]. Preliminary research suggests that long gaming-session may be one of the risk factors for musculoskeletal pain in adolescents [5,6].
How does the high prevalence of musculoskeletal pain in esports impact young athletes? A body of literature document that adolescents reporting pain also describe decreased quality of life , reduced sleep time and quality of sleep [8,9], and suffers from depression and anxiety [10,11]. Specifically, esports athletes with musculoskeletal pain report reduced sleep time and quality; 26% of them sought medical attention, and 16.3% used analgesics, resulting in 5.6 fewer hours of training per week .
Pain during youth is also associated with a variety of issues presenting later in life, including; smoking, obesity, poor mental health, poor sleep, and physical inactivity. Of particular concern is the current uncertainty regarding treatment methods for musculoskeletal pain in adolescents .
These numbers suggest that the high prevalence of pain in esports has an impact and should not be neglected. With the rapid growth in the number of esports athletes, health professionals can only expect an increase in adolescents’ consultations due to esports-related pain complaints.
An office work sport?
The physical demands of esports may be somewhat similar to that of office-based work (with an added stress of competitive sport). Prolonged use of a stationary work is associated with a higher prevalence of wrist and hand symptoms , and prolonged sitting for 2 hours has shown to increase discomfort in all body areas  and increase the number of creative problem-solving errors when performing computer work . Previous research suggests that exercise might be the first line of treatment for work-related musculoskeletal disorders and can reduce pain , along with new episodes of neck [16,17] and shoulder  pain.
Understanding the work demands of office-based work may be one of the key elements to understand the pain complaints among esports athletes and could be a promising approach to prevent and manage pain associated with esports. However, additional research is required to understand this in the context of esports. Currently, the knowledge regarding specific demands of popular esports games, specific medical needs of the young athletes, and the impact of pain on their performance is scarce.
A Call for Action
Our results  constitute an unanswered need; as the popularity of esports continues to evolve into a massive phenomenon, and the number of professional and amateur athletes increases rapidly, it is paramount to provide proper medical attention to esports athletes. However, the knowledge concerning specific and personalized management strategies for this sport is still lacking .
Specific exercise and physical activity interventions are known to be one of the first-line treatments for office-based workers with musculoskeletal complaints [15–17]. The question remains if this approach can be tailored and implemented in the esports community.
Together with the athletes, coaches, and parents, we need to address the specific  needs of esports, e.g., assessing common injuries for different types of games and gaming consoles, the different modes of play, and different demands during the season (Figure 1).
Based on this knowledge, we can start to develop evidence-inspired strategies to support esports athletes to decrease the risk of musculoskeletal pain, and support those with musculoskeletal pain.
Until further evidence arises, we suggest that clinicians working with esports athletes consider the specific demands of esports, ergonomics during play, and encourage physical activities among this population.
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